Improved breastfeeding rates through evidence based changes to guidelines

‌The benefits of breastfeeding to both infants and mothers are well documented. Societal, economic and health benefits of breastfeeding include reductions in: infant infections, cancers in mothers, cardiovascular disorders in both, and costs to the NHS. These benefits underpin World Health Organisation and UK government policies on infant nutrition. However low breastfeeding rates are a public health problem, which our Medicines’ Management Group is helping to address.

The 1980s saw the introduction of clinical practices to reduce pain in labour and expedite the management of labour. However, the wider impact of the analgesics provided during labour, such as fentanyl, are not well known, allowing these practices to remain unchallenged and unchanged. Researchers in the Medicines’ Management Group have been working to explore these potential impacts and how they might affect infant feeding.

Research by the group explored whether it was possible that the drugs commonly provided in labour could affect the complex, and incompletely understood, physiology of breastfeeding. Their findings showed that there was a link between the drugs administered and the subsequent influence on breastfeeding rates, with reductions of up to 40% reported. This has led to improved public and professional awareness, and guidance, on the need to restrict the dosage of drugs used in labour, and enabled midwives to better identify mothers in the greatest need of breastfeeding support:

Raised Global Awareness: A rise in the public awareness of this issue has been achieved with the research being reported across the media through the Times, BBC, Daily Mail, Reuters, and other sources such as theUNICEF UK Baby Friendly Initiative. A rise in professional awareness has also been achieved with the findings presented through the British Medical Journal, clinical guidelines and seven books for clinicians.

The team have also gone on to achieve global impact with healthcare professionals. The groups’ textbooks ensure their findings reach most midwifery students working in English, Farsi and Indonesian. In fact, 40 of 65 UK midwifery courses have adopted the textbook produced by the team, while the book has been purchased by midwives across Australasia, USA, Ireland and Malta.

Changes to Clinical Guidelines:

Citing our work on the association between the dose of fentanyl and breastfeeding, seven guidelines for clinical practice now recommend restrictions on epidural fentanyl doses, as do the clinical protocols of the US Academy of Breastfeeding Medicine.

Our recommendations against high doses, and the need for further research, also went on to be adopted by NICE, whose guidelines form the basis of hospital policies and procedures in the UK and beyond.

Improvements in Breastfeeding Rates:Publication of our work, and guidelines citing it, have been followed by improved breastfeeding initiation in England, with breastfeeding initiation rates improving from 66.2% to 73.7% between 2005/6 and 2010/11.

Health Gains: Some 750,000 infants are born each year in the UK, and research is now showing that

in increase in breastfeeding rates improves health by reducing UK infant hospital admissions for diarrhoea and lower respiratory infections by 2% and 1%, and leads to longer term benefits in decreasing childhood obesity. Breastfeeding has also been shown to have a measurable impact on: sudden infant death, asthma, leukaemia and cardiovascular disease in infants, breast & ovarian cancer in mothers, and diabetes in infants & mother. These health gains also lead to a cost saving for an already overburdened healthcare system.